BMJ case reports
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Case Reports
Two days with a broken knife blade in the neck--an interesting case of Horner's syndrome.
A 25-year-old man presented to the Emergency department in a rural South African hospital after a left, submental neck stab with a knife. Examination was deemed unremarkable, and the patient was discharged, but re-attended 2 days later complaining of a painful, swollen neck. Further examination identified Horner's syndrome, and further investigation revealed that the blade of the knife had remained in the patient's neck. ⋯ This case illustrates the importance of careful history, examination and diagnostic imaging in the management of penetrating neck injuries. Horner's syndrome can be easily missed in a busy Emergency department and may indicate life-threatening pathology in the context of neck trauma. The difficulties in assessing and managing this type of injury are discussed.
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A 22-year-old man presented with recurrent palpable purpuric rash. His clubbing relates to underlying cystic fibrosis (CF) and his rash was identified as CF-related vasculitis, a rare extrapulmonary manifestation of the disease. ⋯ The patient responded well to immunosuppression, which was given on this admission due to worsening of his CF-related vasculitis. He died 18 months within the onset of his initial rash.
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Post-intubation tracheal stenosis is a rare but serious clinical entity that rarely develops when intubation is less than a week. These patients may remain asymptomatic for a variable period and are often misdiagnosed as asthmatic. The authors report a case of a middle-aged lady who was initially misdiagnosed as having acute asthma after brief tracheal intubation.
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Alteplase used for thrombolysis in ischaemic stroke may be complicated by orolingual acute angioedema (OAA), a rare but potentially life-threatening side effect. We report the case of a 32-year-old woman who over 24 h experienced OAA after thrombolysis for an acute ischaemic left hemispheric stroke. We discuss the pathophysiology of this rare phenomenon.
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Case Reports
Spontaneous pneumomediastinum and subcutaneous emphysema in systemic lupus erythematosus.
We report a case of a 29-year-old woman who is known to have systemic lupus erythematosus and idiopathic interstitial pneumonia; she presented with a 1-day history of substernal chest pain and increasing shortness of breath. On examination, she was found breathless, but was not distressed or afebrile or normotensive. Auscultation of the heart revealed a positive Hamman's sign. ⋯ Chest x-ray showed signs of idiopathic interstitial pneumonia in addition to pneumomediastinum (linear band of air within mediastinal planes and continuous diaphragm sign) and chest-wall subcutaneous emphysema. She was treated with high-concentration oxygen. A repeat chest x-ray 5 days later showed complete resolution of the pneumomediastinum and subcutaneous emphysema, but signs of idiopathic interstitial pneumonia continued to persist.